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How to define anemia in children with chronic kidney disease?

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Abstract

In a cross-sectional study, we compared the prevalence of anemia based on age- and gender-specific reference intervals for hemoglobin (Hgb) and hematocrit (Hct) with the Kidney Disease Outcomes Quality Initiative (KDOQI) anemia definition (Hgb < 110 g/L) in 351 children with chronic kidney disease (CKD) stages I–V. Cystatin C-based GFRs were 122 ± 36 mL/min/1.73 m2 in patients with stage I CKD (n = 196), 76 ± 8 mL/min/1.73 m2 for stage II (n = 104), 45 ± 9 mL/min/1.73 m2 for stage III (n = 36), and 22 ± 5 mL/min/1.73 m2 in patients with stage IV+V CKD (n = 15). Fifty-nine patients received iron therapy and 32 patients were treated with Darbepoetin. For Hgb, a total of 90 patients fit the age and gender derived criteria, compared to only 54 patients identified by the KDOQI guidelines (p = 0.0010). Similarly, for Hct, a total of 78 patients fit the age and gender derived criteria, which was a significantly higher proportion than the 56 identified by the KDOQI guidelines (r = 0.22, p = 0.0435). There was a significant correlation between the GFR and both the Hgb Z-score (p = 0.0068) and the Hct Z-score (p = 0.0128). There was poor agreement between conventional and KDOQI definitions of anemia in children with CKD.

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Abbreviations

CKD:

chronic kidney disease

KDOQI:

kidney disease outcomes quality initiative

Hgb:

hemoglobin

Hct:

hematocrit

GFR:

glomerular filtration rate

References

  1. Steinberg E, Eknoyan G, Levin N, Eschbach J, Golper T, Owen W, Schwab S (2000) Methods used to evaluate the quality of evidence underlying the National Kidney Foundation-Dialysis Outcomes Quality Initiative Clinical Practice Guidelines: description, findings, and implications. Am J Kidney Dis 36:1–11

    Article  CAS  Google Scholar 

  2. Lee GR, Bithell TC, Foerster J, Athens JW, Lukens JN (eds) (1993) Wintrobe’s clinical hematology, appendix, 9th edn. Lea & Febiger, Philadelphia, p 2303

    Google Scholar 

  3. KDOQI Update 2000 website (2000) Guideline 1.When to initiate the work-up of anemia. National Kidney Foundation, New York. https://doi.org/www.kidney.org/professionals/kdoqi/guidelines_updates/doqiupan_i.html#1. Accessed 10 October 2005

  4. National Kidney Foundation (2006) KDOQI. II. Clinical practice recommendations for anemia in chronic kidney disease in children. Am J Kidney Dis 47(5 Suppl 3):S86–S108

    Google Scholar 

  5. Fivush BA, Jabs K, Neu AM, Sullivan EK, Feld L, Kohaut E, Fine R (1998) Chronic renal insufficiency in children and adolescents: the 1996 annual report of NAPRTCS. North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 12:328–337

    Article  CAS  Google Scholar 

  6. KDOQI Update 2000 website (2000) II. Target Hemoglobin/Hematocrit. National Kidney Foundation, New York. https://doi.org/www.kidney.org/professionals/kdoqi/guidelines_updates/doqiupan_ii.html. Accessed 10 October 2005

  7. Lowrie EG, Ling J, Lew NL, Yiu Y (1994) The relative contribution of measured variables to death risk among hemodialysis patients. In: Friedman EA (ed) Death on hemodialysis: preventable or inevitable? Kluwer Academic, Boston, MA, pp 121–141

    Chapter  Google Scholar 

  8. Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE (1996) The impact of anemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease. Am J Kidney Dis 28:53–61

    Article  CAS  Google Scholar 

  9. Warady BA, Ho M (2003) Morbidity and mortality in children with anemia at initiation of dialysis. Pediatr Nephrol 10:1055–1062

    Article  Google Scholar 

  10. Hogg RJ, Furth S, Lemley KV, Portman R, Schwartz GJ, Coresh J, Balk E, Lau J, Levin A, Kausz AT, Eknoyan G, Levey AS; National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 111(6 Pt 1):1416–1421

    Article  Google Scholar 

  11. Filler G, Lepage N (2003) Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 18:981–985

    Article  Google Scholar 

  12. Finney H, Newman DJ, Thakkar H, Fell JM, Price CP (2000) Reference ranges for plasma cystatin C and creatinine measurements in premature infants, neonates, and older children. Arch Dis Child 82:71–75

    Article  CAS  Google Scholar 

  13. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(2 Suppl 1):S1–S266

    Google Scholar 

  14. Dallman PR (1977) White blood cells. In: Rudolph A (ed) Pediatrics, 16th edn. Appleton-Century-Crofts, New York, p 1111

    Google Scholar 

  15. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  Google Scholar 

  16. Dharnidharka VR, Kwon C, Stevens G (2002) Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 40:221–226

    Article  CAS  Google Scholar 

  17. Filler G, Priem F, Lepage N, Sinha P, Vollmer I, Clark H, Keely E, Matzinger M, Akbari A, Althaus H, Jung K (2002) Beta-trace protein, cystatin C, beta(2)-microglobulin, and creatinine compared for detecting impaired glomerular filtration rates in children. Clin Chem 48:729–736

    CAS  PubMed  Google Scholar 

  18. Montini G, Zacchello G, Baraldi E, Zanconato S, Suppiej A, Fabris F, Andreetta B, Pavanello L, Zacchello F (1990) Benefits and risks of anemia correction with recombinant human erythropoietin in children maintained by hemodialysis. J Pediatr 117:556–560

    Article  CAS  Google Scholar 

  19. Burke JR (1995) Low-dose subcutaneous recombinant erythropoietin in children with chronic renal failure. Australian and New Zealand Paediatric Nephrology Association. Pediatr Nephrol 9:558–561

    Article  CAS  Google Scholar 

  20. Morgenstern B, Nair KS, Lerner G, Neu A, Quan A, Warady BA (2001) Impact of total body water (TBW) errors on Kt/V estimates in children on PD. Adv Perit Dial 17:260–263

    CAS  PubMed  Google Scholar 

  21. Fadrowski JJ, Furth SL, Fivush BA (2004) Anemia in pediatric dialysis patients in end-stage renal disease network 5. Pediatr Nephrol 19:1029–1034

    Article  Google Scholar 

  22. ESRD clinical performance measures project (2003) 2002 annual report: ESRD clinical performance measures project. Am J Kidney Dis 42(1 suppl 2):S1–S96

    Google Scholar 

  23. Gouva C, Nikolopoulos P, Ioannidis JP, Siamopoulos KC (2004) Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int 66:753–760

    Article  Google Scholar 

  24. Algarin C, Peirano P, Garrido M, Pizarro F, Lozoff B (2003) Iron deficiency anemia in infancy: long-lasting effects on auditory and visual system functioning. Pediatr Res 53:217–223

    Article  CAS  Google Scholar 

  25. Warady BA, Arar MY, Lerner G, Nakanishi AM, Stehman-Breen C (2006) Darbepoetin alfa for the treatment of anemia in pediatric patients with chronic kidney disease. Pediatr Nephrol 21:1144–1152

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada

    Guido Filler, Kyle Mylrea, Janusz Feber & Hubert Wong

  2. Department of Pediatrics, Children’s Hospital of Western Ontario, University of Western Ontario, 800 Commissioner’s Road East, London, ON, N6A 5W9, Canada

    Guido Filler

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  1. Guido Filler
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  2. Kyle Mylrea
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Correspondence to Guido Filler.

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Filler, G., Mylrea, K., Feber, J. et al. How to define anemia in children with chronic kidney disease?. Pediatr Nephrol 22, 702–707 (2007). https://doi.org/10.1007/s00467-006-0397-7

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  • DOI: https://doi.org/10.1007/s00467-006-0397-7

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